Monday, January 10, 2005

When Doctors Go to War

Steven H. Miles concluded last year: "Government documents show that the US military medical system failed to protect detainees' human rights, sometimes collaborated with interrogators or abusive guards, and failed to properly report injuries or deaths caused by beatings" ("Abu Ghraib: Its Legacy for Military Medicine," Lancet 364, August 21, 2004).

(It says a lot about class that the whistle blower who exposed torture at Abu Ghraib was not a medical doctor but a soldier whose mother "lives in a cramped trailer steps from a railroad track, at the edge of a line of trim clapboard houses" [Hanna Rosin, "When Joseph Comes Marching Home: In a Western Maryland Town, Ambivalence About the Son Who Blew the Whistle at Abu Ghraib," Washington Post, May 17, 2004, p. C1] -- Spec. Joseph Darby.)

M. Gregg Bloche and Jonathan H. Marks corroborate Miles' findings and argue that U.S. "physicians and other medical professionals breached their professional ethics and the laws of war by participating in abusive interrogation practices," contradicting the Pentagon's denial that they did:

Not only did caregivers pass health information to military intelligence personnel; physicians assisted in the design of interrogation strategies, including sleep deprivation and other coercive methods tailored to detainees' medical conditions. Medical personnel also coached interrogators on questioning technique. ("When Doctors Go to War," New England Journal of Medicine 352.1, January 6, 2005)

What is particularly chilling is that, having interviewed the medical personnel complicit in military interrogations (some of whom spoke on the record while others did so confidentially), Bloche and Marks discovered that "[p]hysicians who did such work tend not to see these practices as unethical":

On the contrary, a common understanding among those who helped to plan interrogations is that physicians serving in these roles do not act as physicians and are therefore not bound by patient-oriented ethics. In an interview, Dr. David Tornberg, Deputy Assistant Secretary of Defense for Health Affairs, endorsed this view. Physicians assigned to military intelligence, he contended, have no doctor–patient relationship with detainees and, in the absence of life-threatening emergency, have no obligation to offer medical aid.

. . . . . . . . . . . . . . . . . . . .

In helping to plan and execute interrogation strategies, did doctors breach medical ethics? Military physicians and Pentagon officials make a case to the contrary. Doctors, they argue, act as combatants, not physicians, when they put their knowledge to use for military ends. A medical degree, Tornberg said, is not a "sacramental vow" -- it is a certification of skill. When a doctor participates in interrogation, "he's not functioning as a physician," and the Hippocratic ethic of commitment to patient welfare does not apply. According to this view, as long as the military maintains a separation of roles between clinical caregivers and physicians with intelligence-gathering responsibilities, assisting interrogators is legitimate. (emphasis added, January 6, 2005)

The banality of evil indeed. The U.S. medical personnel interviewed by Bloche and Marks compartmentalize and then subordinate their individual conscience, professional ethics, and international laws to dictates of military service, and in their compartmentalization and subordination echoes the final plea of Adolf Eichmann:

I cannot recognize the verdict of guilty. . . . It was my misfortune to become entangled in these atrocities. But these misdeeds did not happen according to my wishes. It was not my wish to slay people. . . . Once again I would stress that I am guilty of having been obedient, having subordinated myself to my official duties and the obligations of war service and my oath of allegiance and my oath of office, and in addition, once the war started, there was also martial law. . . . I did not persecute Jews with avidity and passion. That is what the government did. . . . At that time obedience was demanded, just as in the future it will also be demanded of the subordinate. (emphasis added, "Eichmann's Final Plea")

That future that Eichmann predicted is here now -- or rather it has been with us always, invisible only to those who thought: "It Can't Happen Here."